title: Risk of perioperative blood transfusions and postoperative complications associated with serotonergic antidepressants in older adults undergoing hip fracture surgery.
abstract: Serotonergic antidepressants (SAds) are associated with bleeding-related adverse events. An increased risk of bleeding with SAds may have important implications in surgical settings. Our study evaluates the risk of red blood cell (RBC) transfusions and postoperative complications associated with SAds among older adults undergoing hip fracture surgery. We conducted a retrospective cohort study of individuals 66 years or older who underwent hip fracture surgery in Ontario, Canada. The risk of RBC transfusion among current users of SAds and nonserotonergic antidepressants (NSAds) was compared with recent former SAd users. Secondary outcomes included measures of postoperative morbidity and mortality. Subgroup analyses were undertaken in groups who were coprescribed other medications known to effect bleeding. Multivariable logistic regression was utilized to determine the odds ratios (ORs) for antidepressants and postoperative outcomes. A total 11,384 individuals were included in the study sample. Current SAd users had an increased risk of RBC transfusion compared with recent former users of SAds (OR, 1.28; 95% confidence interval, 1.14-1.43) as did current NSAd users (OR, 1.17; 95% confidence interval, 1.03-1.33). The risk of RBC transfusion with SAds or NSAds was further increased among individuals receiving antiplatelet agents. However, postoperative morbidity and mortality were not increased among either group of antidepressant users. In conclusion, SAds are associated with an increased risk of RBC transfusions, although this does not appear to result in major postoperative complications. Clinicians should be aware of this increased risk, although routine discontinuation of antidepressants before surgery is likely unwarranted in most cases.
authors.affiliation: From the *Division of Geriatric Psychiatry, Department of Psychiatry, Queen's University, Kingston; †Mount Sinai Hospital; ‡Institute for Clinical Evaluative Sciences; §Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto; ∥Department of Medicine, ¶Institute for Clinical Evaluative Sciences, #Department of Anesthesia and Perioperative Medicine, Queen's University, Kingston; **Department of Psychiatry, Sunnybrook Health Sciences Centre and University of Toronto; and ††Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.
authors.forename: Dallas P
authors.initials: DP
authors.lastname: Seitz
authors.forename: Chaim M
authors.initials: CM
authors.lastname: Bell
authors.forename: Sudeep S
authors.initials: SS
authors.lastname: Gill
authors.forename: Cara L
authors.initials: CL
authors.lastname: Reimer
authors.forename: Nathan
authors.initials: N
authors.lastname: Herrmann
authors.forename: Geoffrey M
authors.initials: GM
authors.lastname: Anderson
authors.forename: Alice
authors.initials: A
authors.lastname: Newman
authors.forename: Paula A
authors.initials: PA
authors.lastname: Rochon
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000928:Antidepressive Agents / Q000009:adverse effects* / Q000494:pharmacology / Q000627:therapeutic use; D016063:Blood Loss, Surgical; D015331:Cohort Studies; D017707:Erythrocyte Transfusion / Q000706:statistics & numerical data*; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced / Q000453:epidemiology; D006620:Hip Fractures / Q000601:surgery; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D009864:Ontario; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D012306:Risk; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects* / Q000494:pharmacology / Q000627:therapeutic use
chemical_list: D000928:Antidepressive Agents; D017367:Selective Serotonin Reuptake Inhibitors